| NPI | 1023321072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2016044547) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 118264) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2017-05-19 |